Killer E.coli strain infects first victims in Britain - TheNewTopical.com - current events, politics, culture, ethics, economics discussion forum

FredFredson · #1 (**permalink**) 03-06-11, 12:01 AM

Killer E.coli strain infects first victims in Britain
The deadly new strain of E.coli that has killed 18 people in Europe risks spreading from person to person in Britain, the Health Protection Agency warned last night.

By Steven Swinford

10:06PM BST 02 Jun 2011

Killer E.coli strain infects first victims in Britain - Telegraph

As seven cases of the food poisoning bacteria were diagnosed in Britain, the agency said that the mutant strain was so virulent that sufferers risked spreading the infection to friends and relations through close contact.

With more than 30,000 people travelling between Britain and Germany every day, officials fear the outbreak could take hold here.

The agency said anyone who had recently travelled to Germany should be vigilant about their personal hygiene to minimise the risk of passing on the bacteria, which can attack the kidneys with potentially fatal consequences.

The outbreak is on course to be the world’s “biggest ever”, according to one of the country’s leading microbiologists. The agency added that it was shocked by its “unprecedented” scale and severity. More than 1,600 people have been infected worldwide, mainly in northern Germany. Hundreds have been left seriously ill and at least 18 have died.

It emerged last night that the food bug has struck two Americans who had recently travelled to Hamburg. Both are expected to survive but experts warned that the bacteria could be exported to the US.

The World Health Organisation identified the bacterium as a “completely new” mutant strain which was more toxic and infectious than usual varieties. It is resistant to antibiotics and has an eight-day incubation period, which means that the outbreak may not have reached a peak.

It can cause the deadly complication haemolytic-uraemic syndrome (HUS) which affects the blood and kidneys. The Food Standards Agency said that contaminated produce had not entered the British food chain, although several supermarkets confirmed last night that they were still importing produce from Germany.

Experts are still unable to say where the outbreak originated, having ruled out the initial theory that it came from a consignment of Spanish cucumbers. Fears have heightened to such an extent that Russia yesterday banned the import of all raw vegetables from Europe.

The HPA said the seven cases diagnosed in Britain involved people who had recently travelled to Germany. Three are seriously ill with the HUS complication. Dr Bob Adak, an expert in gastrointestinal infections at the agency, said his organisation had interviewed the families of those involved and advised them to take precautions to avoid a secondary spread of the bacteria.

“We’re extremely concerned by it,” he said. “We are on the lookout for secondary infections, because it is quite infectious you don’t need many bacteria on your hand to spread it.

“People have got to be very careful, in the first instance those who are most at risk are other family members. People who have been to Germany and come back should be careful with their hygiene.

“If they experience abdominal cramps or diarrhoea they should seek medical advice. This illness can develop and spread very quickly. If you have young children in the house you want to protect them.”

E.coli is usually contracted by eating contaminated food, but it can spread from person to person if the strain is infectious enough. People must be particularly careful to wash their hands thoroughly after using the lavatory.

Hilde Kruse, a food safety expert at the WHO, said the strain had characteristics which made it “more virulent and toxin-producing”. Preliminary genetic sequencing suggests that the strain is a new, mutant form of two different E.coli bacteria, according to the WHO. “This is a unique strain that has never been isolated from patients before,” Miss Kruse added.

Unlike previous outbreaks, this strain of E.coli mainly attacks women rather than children or elderly people. More than three quarters of those suffering from serious kidney problems are adult women. Dr Adak added: “The most simple explanation is that because women tend to eat more salad than men and children their risk becomes higher.”

Dr Alexander Mellmann, the scientist who mapped the DNA of the bacteria at the University of Munster in Germany, told The Daily Telegraph that the bacteria had evolved to become more toxic and better at “sticking” to human cells, increasing the chance of infection.

Scientists believe the strain originated in animals such as cattle before spreading to vegetables. The HPA is advising people travelling to Germany to wash salads and to avoid eating raw tomatoes, cucumbers and leafy salads.

Tesco yesterday said it has “small quantities” of cauliflower, cabbage and sweetcorn from Germany in its stores, adding that its suppliers observe the “strictest hygiene standards”. Lidl said it stocks cauliflower from Germany.

The seven people infected in the UK include four German nationals and three British people who recently visited Germany. Three of them are seriously ill with HUS. The other four have suffered from bloody diarrhoea.

Germany has reported 470 cases of HUS and 1,064 cases of bloody diarrhoea. Austria, Denmark, Germany, the Netherlands, Norway, Spain, Sweden and Switzerland have also reported cases, almost all in people who have just returned from Germany.

The Food Standards Agency in Britain has issued general advice on the need to wash fruit and vegetables. Peeling or cooking fruit and vegetables is also known to help remove germs.

FredFredson · #2 (**permalink**) 03-06-11, 12:12 AM

2011 E. coli O104:H4 outbreak - Wikipedia, the free encyclopedia

wikipedia tracking site

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FredFredson · #3 (**permalink**) 03-06-11, 12:19 AM

Scientists Probe Why E. Coli Strain Is So Virulent

by Richard Harris
Scientists Probe Why E. Coli Strain Is So Virulent : NPR

June 2, 2011

The bacterium that is causing all the trouble in Europe is similar to the dreaded E. coli that has caused occasional but deadly outbreaks in the United States and elsewhere in the world. But the strain that has struck Germany is not so well-known to science.

That leaves researchers puzzling over exactly why it's causing so many deaths, and wondering how long the epidemic will last.

At least medical scientists know quite a bit about its method of attack.

"To produce disease it really has to do two things. It has to attach to the intestinal wall and it has to produce toxin that gets absorbed into the body," says Dr. Robert Tauxe at the U.S. Centers for Disease Control and Prevention.

The bacterium, formally known as E. coli O104:H4, actually produces the same toxins that come from the more familiar E. coli O157:H7. But the germ in Europe uses a different method to attach to the intestine.

It's caused so many deaths that it has left medical researchers wondering whether the bacterium's method of attack is especially deadly or if it simply has spread to a whole lot of people.

"That's the key question," Tauxe says. "And the answer is not entirely clear."

This is somewhat uncharted territory. A Chinese genetics lab reported today that it actually sequenced the DNA of the germ, and it considers it a new variant. But Tauxe says the strain of E. coli is actually not entirely new.

"We have not seen outbreaks in contaminated food before," he says. "But there have been isolated cases identified in the past, in a number of different countries around the world."

Dr. Phillip Tarr from Washington University in St. Louis has seen more than his share of disease caused by this sort of bacterium. He is a pediatrician who has treated children afflicted with other dangerous strains of E. coli.

"What we think happens is the toxins get into the bloodstream and injure the blood vessels," he says. "And the blood vessels form little clots, and there's impaired blood flow to organs throughout the body."

This condition is called hemolytic uremic syndrome, and it hits the kidneys hard. In Germany, 470 people have been diagnosed with this severe condition. Usually, Tarr says, more than half of people who get this disease need kidney dialysis.

"In almost all cases it's temporary," he says. "Dialysis lasts a median of about eight days."

But dialysis doesn't save everybody, as is clearly the case in Europe. Tarr says obviously the first priority now is to figure out the best care for people currently sickened by the disease.

"After this is over we really need to determine how it could have been prevented, if possible, and how to prevent it in the future," he says. "And right now we need to know where it's coming from."
Related NPR Stories
Rare Form Of E. Coli To Blame For Outbreak June 2, 2011
Rare Bacterial Strain Identified As Cause June 2, 2011
Outbreak Sparks Political Tension In Europe June 2, 2011

Surveys of people who got sick found they were more likely to have eaten fresh tomatoes, lettuce and cucumbers. But that doesn't prove that the disease is actually from produce. And even if investigators can prove that link, Tauxe from the CDC says that raises the question of where the produce came from.

"Tracing back the origin of fresh produce, we learned in this country, can take a long time," says Tauxe. "And I'm sure it's the same in Germany."

The case could also be getting cold. People diagnosed today could have eaten bad food a week or two ago. And with that lag time, the epidemic will probably fizzle out slowly, Tauxe says.

If the contaminated food is a fresh vegetable, the normal food safety tips won't necessarily protect you.

"Unfortunately these bacteria tend to be sticky and it's difficult to wash them off fresh vegetables," he says. "And sometimes they're even inside."

So this is one time when boiled cabbage could actually start to sound like an appealing option.

FredFredson · #4 (**permalink**) 03-06-11, 05:50 PM

E coli cases in Europe exceed 1,600

Robert Roos

News Editor

Jun 2, 2011 (CIDRAP News) – The official toll of enterohemorrhagic Escherichia coli (EHEC) cases in Europe climbed above 1,600 today, with at least 16 deaths, as the pathogen's source remained elusive and one team of scientists called the strain new and "super-toxic."

The World Health Organization (WHO) said today that the outbreak grew to 1,614 cases in Europe, including 1,115 cases classified as EHEC only and another 499 that involved hemolytic uremic syndrome (HUS), or potentially fatal kidney failure. The proportion of HUS cases and the percentage of HUS cases in adults (88%) have both been far higher than is usually seen in E coli outbreaks.

In Germany, 9 patients have died of HUS and another 6 have died of EHEC, and one person in Sweden has died, the WHO said. But an Associated Press (AP) report today put the total death toll at 18. Most cases have occurred in Germany, but nine other European countries have also had illnesses.

Three people in the United States are now hospitalized with HUS cases suspected to be related to the European outbreak, Lola Russell of the US Centers for Disease Control and Prevention told CIDRAP News today. The count is up one since yesterday.

Today's case numbers seemed to signal that the outbreak is slowing down little, if at all. A report published today in Eurosurveillance, covering events to May 31, showed that the daily number of HUS cases reported in Germany peaked at 39 on May 16 and has been generally dropping since then. But today's WHO statement noted that the number of German HUS cases yesterday was 470, an increase of 97 from the day before.

Also, because of the delay in reporting of cases, the Eurosurveillance report said, "The current notification data cannot be interpreted as a decrease in case numbers." The report was authored by specialists from Germany's Robert Koch Institute and the European Centre for Disease Prevention and Control in Stockholm.

Despite multiple investigations, there was no official word today of new clues about the source of the pathogen, the rare E coli strain O104:H4. Case-control studies have cast suspicion on cucumbers, tomatoes, and lettuce sold in northern Germany. But the outbreak strain has not been found on any of those items, despite an early finding of a pathogenic E coli strain on some Spanish cucumbers tested in Hamburg.

Meanwhile, a Chinese genomics laboratory, BGI (formerly the Beijing Genomics Institute), announced today that it has sequenced the outbreak strain and completed "a preliminary analysis that shows the current infection is an entirely new super-toxic E coli strain." The analysis was done by BGI-Shenzen in collaboration with the University Medical Centre Hamburg-Eppendorf, the BGI statement said.

The analysis confirmed that the pathogen is an E coli O104 but said it is a new serotype, "not previously involved in any E coli outbreaks," according to BGI. The strain is 93% similar to a strain found in the Central African Republic, but it has acquired sequences that seem similar to those involved in causing "hemorrhagic colitis" and HUS, the statement said.

The statement also said the E coli strain carries genes that confer resistance to several classes of antibiotics. Earlier reports from Europe had said the strain was resistant to multiple drugs.

A WHO official agreed that the outbreak strain is new, according to the AP report. "This is a unique strain that has never been isolated from patients before," said Hilda Kruse, a WHO food safety expert.

Earlier this week, the CDC called the outbreak strain very rare but not brand new. In today's AP story, Dr. Robert Tauxe, a CDC foodborne disease expert, said the strain was seen in a case in Korea in the 1990s. He said the genetic fingerprints of the current strain and the Korea one may vary slightly, but not enough to call the European strain new, according to the AP.

Craig Hedberg, PhD, a foodborne disease expert at the University of Minnesota School of Public Health in Minneapolis, cautioned that there is still too little information, genomic or otherwise, to explain why the outbreak strain is causing so many severe illnesses.

"I think it is too early to fully characterize this agent and what makes it as virulent as it appears to be," Hedberg commented by e-mail. "The rapid genomic analysis presents some interesting information, but detecting a gene is not the same as demonstrating what it means from the standpoint of disease transmission.

"The large number of cases diagnosed with HUS implies either a highly pathogenic organism, or a very large population exposed to the vehicle. It is too soon to really make those distinctions. A relatively small case-control study seemed to implicate fresh produce items, and this is certainly consistent with the demographics of the outbreak, but the size and distribution of the outbreak is also somewhat difficult to explain with a contaminated, imported produce item.

"Something very unusual has happened (is happening?), and we cannot be certain what it is," he added.

Referring to Tauxe's comments, Hedberg agreed that an HUS case involving a similar strain occurred in a 29-year-old Korean woman. "How this appeared suddenly and overwhelmingly in northern Germany is very disturbing," he said.

He also commented that the Robert Koch Institute has already learned much about the strain and shown that it has an unusual combination of features, but said the full extent of its virulence and its pathogenic mechanisms still need to be determined.

"The fact that it is a multi-drug resistant organism that is ESBL [extended-spectrum beta-lactamase]-positive may also have implications about the origin of the pathogen (ie, human source more likely than food animal source)," Hedberg said. "Much more will be learned about this as things develop."

Today's Eurosurveillance report gave a long list of continuing investigations into the outbreak, including case-control studies and an inquiry into human-to-human transmission in a "special outbreak in a canteen."

The report also said that among 13 deaths reported in Germany, 8 of the victims were between 75 and 91 years old, while the other 5 were between 22 and 40.

See also:

Jun 2 WHO statement

Jun 2 Eurosurveillance report

Jun 2 BGI press release

European Commission statement asking Russia to withdraw ban on produce from EU

FredFredson · #5 (**permalink**) 05-06-11, 05:03 PM

German hospitals swamped with E.coli victims
Sun Jun 5, 2011 11:42am EDT

By Brian Rohan

German hospitals swamped with E.coli victims | Top News | Reuters

HAMBURG (Reuters) - German hospitals are struggling to cope with the flood of E.coli victims, Health Minister Daniel Bahr said on Sunday, as the death toll rose to 21 with more than 2,000 people infected across Europe.

Also on Sunday, officials in the northern state of Lower Saxony said they were investigating a local fruit and vegetable supplier suspected of passing on contaminated produce, a spokesman from the state consumer protection office said.

Hospitals in the northern port of Hamburg, epicenter of the outbreak that began three weeks ago, have been moving out patients with less serious illnesses to handle the surge of people stricken by a rare, highly toxic strain of the bacteria.

"We're facing a tense situation with patient care," Bahr told the Bild am Sonntag newspaper on Sunday. He added hospitals outside Hamburg could be used to make up for "insufficient capacity" in Germany's second largest city.

At a news conference with Bahr in Hamburg, state health minister Cornelia Pruefer-Storcks said local officials were scrambling to relieve a looming shortage of doctors.

"We want to discuss with doctors about whether those who recently retired can be reactivated," she said, adding that medical staff in Hamburg was battling exhaustion.

Bahr later told N-TV network: "Those hospitals with enough capacity are supporting those that don't have enough capacity. That's the way we're getting control of the situation."

He reiterated the government's warning for consumers to stay away from tomatoes, cucumbers and lettuce in northern Germany.

Authorities in Germany are racing to track down the source of the pathogen, which has infected people in 12 countries -- all of whom had been traveling in northern Germany.

Reinhard Burger, president of the Robert Koch Institute, the German center for disease control, said on Sunday the death toll had risen to 21.

Officials believe people were made ill by eating lettuce, tomatoes, cucumbers or other raw salad vegetables in Germany. Scientists suspect the source of the contamination may have been poor hygiene at a farm, in transit, or in a shop or food outlet.

Many of those infected have developed haemolytic uraemic syndrome (HUS), a potentially deadly complication attacking the kidneys.

DINERS AVOID SALADS

The rare strain of E.coli has the ability to stick to intestinal walls where it pumps out toxins, sometimes causing severe bloody diarrhoea and kidney problems. Some patients have needed intensive care, including dialysis. It has hit women more than men, and most of those who have died were elderly.

A spokesman for the Regio Clinics, the largest private hospital in the state of Schleswig-Holstein that surrounds Hamburg, said the crisis was straining resources.

"All the hospitals in the region are pushing their limits," said the spokesman. "We can handle it but some of our patients have to be sent to other hospitals, especially those with HUS or needing dialysis."

He added: "Operations for non-life-threatening illnesses are being rescheduled."

Officials had identified a restaurant in the northern port city of Luebeck as a possible place where the bug had been passed to humans after at least 17 people infected with E.coli had eaten there and one later died from complications.

The proprietor of the German meat-and-potatoes restaurant told Reuters his kitchen tested negative for the deadly E.coli strain and none of his staff had fallen ill.

People in Hamburg were steering clear of salads.

"I'm a vegetarian, so it hits me especially hard," said taxi driver Wolfgang Roenisch. "I've stopped eating cucumbers, tomatoes and salad."

But Amin Najibi, owner of a small restaurant, said there were still fearless salad-eaters: "We're still serving salad though demand has fallen a bit. I think people are eating normally."

The Lower Saxony state consumer protection ministry is planning a news conference in Hanover at 1600 GMT to release details of its investigation into the produce supplier.

The ministry spokesman said many restaurants had received produce from the local company. "The epidemilogists believe that this is a hot lead," the spokesman said.

(Writing by Eric Kelsey; editing by Jon Boyle)

© Thomson Reuters 2011 All rights reserved.

Zichao · #6 (**permalink**) 05-06-11, 07:55 PM

I was in Strasbourg the other week, but I reckon if I was going to die it'd have happened already.

FredFredson · #7 (**permalink**) 06-06-11, 05:11 PM

Sprouts linked to European E coli outbreak

Lisa Schnirring * Staff Writer

CIDRAP >> Sprouts linked to European E coli outbreak

Jun 5, 2011 (CIDRAP News) – German officials today announced that they have tentatively linked bean sprouts grown in the northern part of the country to a massive Escherichia coli outbreak, a development that US experts say could help explain some of the outbreak's puzzling elements.

At a news conference today, officials from Lower Saxony state said initial tests have confirmed that bean sprouts are the likely cause of the outbreak, the Associated Press (AP) reported.

In other outbreak developments over the weekend, German authorities are investigating if a Hamburg harbor festival that took place May 6 to 8, drawing more than 1.5 million visitors from Germany and other countries, may have played a role in the spread of the disease, Agence France-Presse (AFP) reported yesterday. Also, officials are investigating illness clusters at two restaurants in Lubeck, located 40 miles from Hamburg.

The European Centre for Disease Prevention and Control (ECDC) today said it has received reports of 1,605 enterohemorrhagic E coli (EHEC) O104:H4 infections and 658 cases of hemolytic uremic syndrome (HUS). HUS is a potentially fatal kidney condition that stands out in this outbreak because the proportion of cases has been far higher than typically seen in E coli outbreaks.

So far 22 deaths have been reported, 16 of which occurred in patients who had HUS.

The ECDC report also said that more than two thirds of cases have been in women. It said the "great majority" of cases have been in adults.

Gert Lindemann, the state's agriculture minister, told reporters that different kinds of sprouts grown at an organic farm near Uelzen have been linked to infected patients in five different German states. He said investigators are looking at 18 different sprout mixtures, such as bean, broccoli, pea, chickpea, lentil, and radish.

Officials have shut down the farm and recalled the rest of its products, which include fresh herbs, fruit, flowers, and potatoes. Lindemann said at least one of the farm's employees had an E coli infection, the AP reported.

He said definitive test results will be available tomorrow and warned Germans not to eat sprouts until further notice, according to the AP. Authorities have still not ruled out other possible sources of the E coli outbreak strain, so Lindemann urged the public to continue to avoid tomatoes, cucumbers, and lettuce.

Another agriculture official added that the sprouts were delivered to many restaurants that have been linked to illness clusters.

The investigation of the E coli outbreak involving the extremely rare O104:H4 subtype surfaced in mid May and has stumped German health officials, who originally linked the outbreak to Spanish cucumbers, lettuce, and possibly tomatoes. The identification of the outbreak strain also sparked scientific debate over whether E coli O104:H4 is a new or unique strain.

US experts weigh in
While food safety experts wait for further test confirmation and more information on the lab results, some said the sprout source could explain some of the more puzzling aspects of the outbreak. Craig Hedberg, PhD, a foodborne disease expert at the University of Minnesota, told CIDRAP News that sprouts, if definitively identified as the source, would fit well with much of the other available data.

"They are a fresh produce item that would be more commonly eaten by women, and they are produced and distributed over a limited geographic area," he said. "Also the conditions needed to grow sprouts are perfect for incubating pathogens like EHEC. If these are bean sprouts, they are relatively large, and could have carried a relatively high dose."

Hedberg said it's unfortunate that the sprout connection wasn't identified sooner.

In the United States, alfalfa sprouts have been linked to several foodborne illness outbreaks. In 2009 the federal officials warned consumers not to eat raw alfalfa sprouts, including sprout blends, because they suspected alfalfa seeds used by the nation's sprout growers could be contaminated with Salmonella.

Michael Osterholm, PhD, MPH, director of the University of Minnesota's Center for Infectious Disease Research and Policy, publisher of CIDRAP News, said he's not surprised that sprouts appear to be the culprit, and that they should have been explored early on as one of the possibilities.

The outbreak's potential link to the Hamburg festival might explain the large numbers of patients with HUS, he said. "A festival setting could lead to the rapid dissemination of a pathogen like E coli in food, he said."The denominator may be extremely large."

"The festival gives that possibility, and we may find out that the E coli subtype is not more virulent," Osterholm said.

In 1988 an uncooked tofu salad served at a 5-day music festival in Michigan sickened 3,175 people with shigellosis, according to a report on the outbreak that appeared in the Mar 15, 1991, issue of the American Journal of Epidemiology. The illness onset peaked 2 days after the festival ended, and sick patients were turning up throughout the United States by the time the outbreak was identified.

See also:

Jun 5 AP story

Jun 5 ECDC update

1991 Am J Epidemiol abstract

Jun 3 CIDRAP News story "Four US cases may be tied to European E coli outbreak"

Zichao · #8 (**permalink**) 06-06-11, 06:29 PM

I've heard people trying to blame this on the manure that they use as fertilizer on organic farms. The problem is that you don't grow beansprouts in soil, so you're back where you started.

FredFredson · #9 (**permalink**) 09-06-11, 10:29 PM

New E coli findings put spotlight back on sprouts

Lisa Schnirring * Staff Writer

CIDRAP >> New E coli findings put spotlight back on sprouts

Jun 8, 2011 (CIDRAP News) – German health officials investigating a large Escherichia coli outbreak released new findings today that cast more suspicion on bean sprouts, though tests on a cucumber found in a sick family's compost reportedly yielded the outbreak strain.

Gert Hahne, a spokesman for Lower Saxony state's Consumer Protection Ministry, said 18 people who became will with the enterohemorrhagic E coli (EHEC) O104:H4 outbreak strain got sick after eating sprouts from an organic farm that were served in their company cafeteria in Cuxhaven.

The latest findings push the number of illness clusters to seven, which include about 100 people who got sick after eating at four company cafeterias and three restaurants that are known to have received sprouts from the farm.

On Jun 5, health officials in Lower Saxony state tentatively linked bean sprouts grown at an organic farm in the northern part of the country to the massive EHEC outbreak based on initial tests. But more extensive tests conducted so far on samples from the facility haven't turned up the outbreak strain.

Also, Hahne said three women who worked at the farm and helped package the sprouts were sick with diarrhea during the first half of May, and one of the women had a confirmed EHEC infection. He said that a sick worker could have contaminated the sprouts or could have been sickened by the sprouts on the farm.

The spokesman said that, despite the new clues pointing to sprouts, it is possible that the contamination responsible for the outbreak could have come from multiple sources, Der Spiegel reported.

Shortly after Lower Saxony officials announced the latest sprout farm findings, the health ministry in neighboring Saxony Anhalt state said lab tests detected the E coli O104:H4 strain on a piece of cucumber found in the compost bin of a family that was sickened in the outbreak, the Associated Press (AP) reported today. The cucumber had been in the bin for 2 weeks.

In the family of three, the father had experienced diarrhea, the mother had been hospitalized for several days, and the couple's 22-year-old daughter has been hospitalized for 2 weeks with hemolytic uremic syndrome (HUS), a sometimes fatal kidney condition that has struck an unusually high number of patients in the outbreak.

However, a ministry spokesman said it was impossible to determine if the family contaminated the cucumber or if the cucumber was the source of the pathogen. Earlier in the outbreak, investigators wrongly pegged Spanish cucumbers as the source of the outbreak. German authorities are still advising people to avoid eating cucumbers, tomatoes, lettuce, and sprouts.

Craig Hedberg, PhD, a foodborne disease expert at the University of Minnesota, told CIDRAP News that "dumpster diving" isn't an ideal method for identifying the source of a foodborne disease outbreak. "A positive finding in household garbage from a confirmed case may just reflect the presence of the agent in the household, which was already established," he said.

Most of the investigation findings point back to a sprout source, and microbiological testing a month after the fact doesn't change that, Hedberg said. "Negative micro results cannot negate positive epi results. This is an important principle that we cannot state too strongly."

Germany's health minister Daniel Bahr said today that the number of new EHEC infections is declining, but he added that the outbreak is not over, according to the Der Spiegel report. He spoke to reporters at a press conference in Berlin that followed a meeting with health officials.

The European Centre for Disease Prevention and Control (ECDC) in its latest update today said 2,021 EHEC cases have been reported from EU countries, as well as 722 cases of HUS. Twenty-five EU deaths have been linked to the outbreak. The total represents 266 more infections, 48 more HUS cases, and 2 more deaths since yesterday.

Today EU member countries began using a new case definition for HUS, and said totals for France, Sweden, and the Netherlands have undergone minor adjustments to reflect the change, the ECDC said.

The Robert Koch Institute (RKI), the German government's infectious disease body, said today that HUS and EHEC surveillance data and tracking of bloody diarrhea in emergency departments shows an overall decreasing trend in the number of cases. "It is presently uncertain whether this decline is due to changes in dietary consumption of cucumbers, tomatoes, and lettuce or to the waning of the source of infection," RKI said in a statement posted on its Web site.

It said an earlier case-control study questioned patients about sprout consumption, but only a small proportion said they had eaten them. However, the RKI said its investigators are conducting a third study to further tease out the consumption of salad ingredients, including sprouts, as well as other risk factors.

See also:

Jun 8 Der Spiegel story

Jun 8 AP story

Jun 8 ECDC update

Jun 8 ECDC background on new HUS case definition

Jun 8 RKI update

FredFredson · #10 (**permalink**) 20-06-11, 02:09 PM

Amid new E coli cases, Germans detail disease-reporting problems

Robert Roos * News Editor

CIDRAP >> Amid new E coli cases, Germans detail disease-reporting problems

Jun 16, 2011 (CIDRAP News) – Total cases in the Escherichia coli O104:H4 outbreak centered in Germany exceeded 3,400 today as German officials acknowledged that a cumbersome disease-reporting system slowed the early response to the problem.

The Europe-wide case count reached 3,401, with 39 deaths, according to the European Centre for Disease Prevention and Control (ECDC). The total included 823 hemolytic uremic syndrome (HUS) cases, 2 more than yesterday, and 2,578 E coli cases without HUS, including 48 new ones, all of them in Germany. There were 2 more deaths, both in HUS patients in Germany.

Meanwhile, a team of German authors writing in Eurosurveillance today said the existing surveillance system in their country was inadequate in the context of the E coli outbreak, as it took up to 16 days for reports of cases to move from local officials to the national disease-control authority, the Robert Koch Institute (RKI).

The article explains that under the established surveillance system, reports of Shiga toxin–producing E coli (STEC) and HUS cases travel a long road. The clinical laboratory or physician submits reports to the local health authority, which must validate them before sending them on to the state authority "by the third day of the following week." The state authority again validates them and passes them to the national level within the following week.

"The rather long time limits permitted for communicating information on cases from the local to the state/national level led to delayed recognition of this outbreak," the article says. "The first report at the national level was received on 18 May 2011, while the first outbreak-associated cases fell ill on 1 May, with a sharp increase in case numbers on 9 May. This is a limitation requiring further evaluation."

After the outbreak was recognized, health officials took steps to speed the flow of data to the RKI, centralize the exchange of epidemiologic information, launch active lab surveillance, and implement a syndromic surveillance system for bloody diarrhea in emergency departments, according to the report. These enhancements of the surveillance system were "rapidly and effectively implemented," it says.

Germany's disease reporting and response system came in for some criticism from the editors of Nature today. In an editorial, they referred to the country's "bizarrely complicated system" for responding to disease outbreaks and "an alarmingly outdated way of transmitting information between physicians and agencies."

The editorial lays some of the blame on Germany's federalized system, which, in the wake of World War II, was designed to minimize centralization and delegate many responsibilities, including health, to the states.

"Clearly, a way must be found to make an exception to the devolved-responsibility rule, at least when it comes to infectious diseases," the editorial states. "The Robert Koch Institute, which has proven itself extremely competent in handling its part of the E. coli crisis given the blocks put in its way, needs much more power."

In addition, in an epidemic, the German government needs to speak to its people with one voice, which should be the RKI, the article says.

See also:

Jun 16 Eurosurveillance report

Jun 16 ECDC case numbers

Jun 15 ECDC case numbers

Jun 16 Nature editorial